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Article Dans Une Revue European Journal of Heart Failure Année : 2022

Sequencing and Titrating Approach of Therapy in Heart Failure with Reduced Ejection Fraction Following the 2021 ESC guidelines: an International Cardiology Survey

1 CHU Rouen
2 OSU - Ohio State University [Columbus]
3 Hôpital Haut-Lévêque [CHU Bordeaux]
4 ZOL - Ziekenhuis Oost-Limburg
5 UHasselt - Hasselt University
6 UPB - Universidad Pontificia Bolivariana
7 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
8 Glostrup Hospital
9 Medical University of Plovdiv
10 Sechenov First Moscow State Medical University
11 Hospital de Santa Cruz
12 Centro Cardiologico Monzino [Milano]
13 UNIMI - Università degli Studi di Milano = University of Milan
14 St Bartholomew's Hospital (London)
15 LUMC - Leiden University Medical Center
16 University Hospital Centre Zagreb
17 Uniklinik Köln - Universitätsklinikum Köln
18 Bnai Zion Hospital
19 CIC1407 - Centre d'Investigation Clinique [Bron]
20 Hôpital Louis Pradel [CHU - HCL]
21 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
22 UNITO - Università degli studi di Torino = University of Turin
23 GHIB - German Heart Institute Berlin [Berlin, Germany]
24 CARIM - Cardiovascular Research Institute Maastricht
25 MUMC - Maastricht University Medical Centre
26 Massachusetts General Hospital [Boston]
27 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
28 Service de cardiologie et de pathologie vasculaire [CHU Caen]
29 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
30 Hôpital Charles Nicolle [Rouen]
31 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
32 Université de Lille
33 Institut Pasteur de Lille
34 CHU Henri Mondor [Créteil]
35 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
36 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
37 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
38 IRCCS San Raffaele Pisana - Istituto di Ricovero e Cura a Carattere Scientifico
39 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
40 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
Anders Barasa
  • Fonction : Auteur
Fadel Bahouth
  • Fonction : Auteur

Résumé

Aims: In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists.Methods and results: An independent academic web-based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1 year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32-47] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was ≤40% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors first (74%), beta-blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium-glucose cotransporter 2 inhibitors (53%) fourth. Eighty-four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers.Conclusion: In a broad international cardiology community, the 'historical approach' to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices.
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Dates et versions

hal-03862734 , version 1 (05-12-2022)

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Paternité - Pas d'utilisation commerciale - Pas de modification

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Charles Fauvel, Guillaume Bonnet, Wilfried Mullens, Clara Ines Saldarriaga Giraldo, Anja Zupan Mežnar, et al.. Sequencing and Titrating Approach of Therapy in Heart Failure with Reduced Ejection Fraction Following the 2021 ESC guidelines: an International Cardiology Survey. European Journal of Heart Failure, 2022, ⟨10.1002/ejhf.2743⟩. ⟨hal-03862734⟩
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